The Evolution of Drug Checking

Part Two of Three: The “Who” of Drug Checking

By: Shelby Arena

       Part One of this series explored the “what” and “how” of drug checking, following the evolution of the technology from reagent kits to machine spectroscopy, and exploring the strengths and limitations of the various methods. This second installment will look at the “who” of drug checking, identifying the groups, communities, institutions, and individuals that use, develop, and fund drug checking initiatives. Central questions include who benefits from this technology, who are the champions of drug checking development, and how people who use drugs are centered, or not, in the process.

       As article one illustrated, drug checking was founded by chemical scientists for the purpose of forensic research. These tools were later more widely used by law enforcement agencies to analyze seized drugs, inform toxicology reports, and used as evidence in criminal investigations (Reynolds, 2007). At the same time, grassroots harm reductionists have found ways to utilize this technology to inform people who use drugs about what substances are present in a drug sample. For those reasons, the “who” of drug checking has been split between institutions using this technology for science and law and the people on the ground simply looking for answers about what is in the unregulated drug supply. This article will explore three main groups of people invested in drug checking: People Who Use Drugs (PWUD), institutional providers or agencies, and funders.

People Who Use Drugs

       PWUD utilize drug checking services for several reasons, including risk reduction, overdose prevention, and to share information with their peers (Moran et al., 2024). Some PWUD utilize drug checking prior to drug use to gain a better understanding of the makeup of a sample and use that information to inform how much of the drug to take and what other harm reduction strategies to implement. Other PWUD might access drug checking services after using a substance, especially if they have an unexpected experience with a substance. There have even been reports of people who distribute drugs accessing checking services either prior to distribution or after a reported negative effect to gain a better understanding of their supply (Bardwell et al., 2019).

       People have different preferences when it comes to the type of drug checking they utilize. For the most part, xylazine test strips are requested by people using opioids to check for the presence of the tranquilizer in their supply. This same group of people does not often utilize fentanyl test strips, as it is expected that the illicit opioid supply contains fentanyl. Fentanyl test strips are more frequently utilized by people using stimulants like cocaine and methamphetamine, as well as pills of unknown origins (Weicker, 2020).

       Drug checking machines are most often accessed by people who already have a relationship with the organization hosting the machine. In New York State, drug checking machines are available at Drug User Health Hubs and are primarily utilized by individuals who are already accessing services (such as treatment or syringe services) at the agency. In other parts of the country and world, drug checking machines are more accessible at public events like music festivals. With portable FTIR technology, some agencies have implemented mobile drug checking services, taking “meeting people where they are” literally (Karch et al., 2021).

       In the past, reagent testing has been popular at music festivals, as this type of drug checking is great for testing drugs that are commonly used at festivals like MDMA and LSD. Reagent testing at festivals has been declining in popularity in recent years due to legal restrictions and perceived liability for festival hosts.

Harm Reduction Organizations and Public Health Agencies

        PWUD often access drug checking services through harm reduction organizations and public health agencies. These organizations offer various community-based services, including mail-based test strips, mobile drug checking (using portable technology to meet folks in their community), fixed, on-site machine drug checking, and mail-based drug checking. Organizations like MATTERS not only equip organizations with bulk supplies of test strips for local distribution, but also have direct-to-consumer services like mail-based test strip distribution and access through harm reduction vending machines. Other organizations offer in-person access to drug checking supplies like test strips and FTIR machines. Some organizations also offer mail-based access to GC-MS drug checking for an even more detailed result. These organizations serve as a bridge between technological innovations and the individuals at risk for overdose or in need of more information about what is in the drug supply. Ultimately, the goal is to provide individuals with the information they need to make informed, real-time decisions about their drug use. Additionally, these groups often act as a bridge between PWUDs and macro-level stakeholders like clinical laboratories.

Law Enforcement and Clinical Applications

On a systems level, groups like law enforcement, medical examiners, and clinical labs often use drug checking services for forensic purposes, either to inform the course of treatment or to provide information related to an investigation. In some communities, law enforcement drug checking information is the only data the public has access to that provides insight into what is in the drug supply. For example, High Intensity Drug Trafficking Areas (HIDTA) releases quarterly reports on their drug seizures, publicly providing information on what adulterants and cuts are found in the drug supply.”

Funders

       Drug checking initiatives are funded by various sources. Many initiatives focused on public health are funded by various governmental entities like the National Institutes of Health, Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, and state and local agencies. Other programs are funded through non-profit and grassroots organizing. Additionally, the private sector also has a significant influence on drug checking spending, as test strip manufacturers and drug checking machine companies are marketing to both harm reduction organizations and law enforcement agencies. The differing priorities and goals of these two groups cause debate in the public health sphere and raise the question: What is the priority of drug check initiatives?

Conclusion

        The “who” of drug checking is diverse, from grassroots harm reductionists to forensic medical examiners. The motivations for using drug checking also differ, from supporting risk reduction to drug supply surveillance, medical treatment, and legal evidence. Drug checking technology can meet all these needs. However, there is tension between the field’s origins in use for criminal justice measures and its current use for harm reduction. The future of drug checking requires a balance between these competing interests and ensuring legal accessibility for those who need these life-saving services the most: People who use drugs.